This summer, the Federal Trade Commission (“FTC”) and U.S. Department of Justice (“DOJ”) (together “antitrust agencies” or “agencies”) continued to push boundaries on what constitutes anticompetitive conduct with the withdrawal of key healthcare policy statements and heightened scrutiny of the pharmaceutical industry. This summer also saw the DOJ and FTC score crucial enforcement wins in … Continue Reading
The U.S. Department of Justice (“DOJ”) recently withdrew three policy statements regarding conduct in the healthcare sector. The statements withdrawn are the Department of Justice and FTC Antitrust Enforcement Policy Statements in the Health Care Area (dated September 1993); the Statement of Antitrust Enforcement Policy in Health Care (dated August 1996); and the Statement of … Continue Reading
The Centers for Medicare & Medicaid Services (CMS) recently announced its Better, Smarter, Healthier initiative, part of which plans on tying “30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of … Continue Reading
Board members for organizations of all sizes need to be familiar with the OIG’s recent publication of Practical Guidance for Health Care Governing Boards on Compliance Oversight. This informative guide is intended to assist the Board member of any health care organization fulfil compliance obligations with the myriad of health care laws and regulations. Although … Continue Reading
Last Thursday, September 12, 2013, the Department of Health and Human Services (“HHS”) reported that the rate review provisions (the “Rate Review Provisions”) of the Affordable Care Act (“ACA”) saved an estimated $1.2 billion on health insurance premiums in 2012 for 6.8 million policyholders. The Rate Review Provisions are intended to increase transparency behind premium … Continue Reading
Proposed Rules Issued Extending Protections of Electronic Health Record Donations On April 10, 2013, the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and the DHHS, Centers for Medicare & Medicaid Services (CMS) each issued a proposed rule relating to the donation of interoperable electronic health records software or information technology … Continue Reading
Squire Sanders attorneys, Chris Gordon, a Principal in the Washington, D.C. office, and Rob Nauman, a Senior Associate in the Columbus, Ohio office, were recently interviewed by Modern Healthcare for their take on the relaxation of the interim final rule on waivers of fraud and abuse laws and the antitrust policy statement on ACOs. Their … Continue Reading
Today at 2:00 P.M. (EDT), please join Squire Sanders and Strategic Health Care for our complimentary webinar overview of the final rule recently released by the Centers for Medicare & Medicaid Services (CMS) and the opportunities it presents for Accountable Care Organizations (ACOs). Speakers will include our own John Kirsner and Peter Pavarini as well as … Continue Reading
This post has been contributed by Chase Matson, Manager, Government Relations, AMDR When we published last week’s blog post, Medicare ACO Rules Near Final Hurdle, we knew it would only be a matter of time before CMS released its final ACO regulations. Sure enough, only two days later, CMS officially published their long-anticipated rules, ending … Continue Reading
On Thursday, November 3rd, please join Squire, Sanders & Dempsey and Strategic Health Care for a complimentary webinar overview of the final rule recently released by the Centers for Medicare & Medicaid Services (CMS) and the opportunities it presents for Accountable Care Organizations (ACOs). As reported by the Accountable Care Forum, CMS made significant changes in … Continue Reading
On October 20, 2011, the Department of Justice and Federal Trade Commission jointly issued their “Final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medical Shared Savings Program.” The policy statement, which largely mirrors the agencies’ proposed policy statement issued on April 19, 2011, outlines how the agencies will enforce U.S. … Continue Reading
Concurrently with the release of the final rule for accountable care organizations participating in the Medicare Shared Savings Program (“MSSP”), the Centers for Medicare and Medicaid Services (“CMS”) and the Department of Health and Human Services, Office of Inspector General (“OIG”) released an interim final rule with a comment period addressing waivers of certain fraud … Continue Reading
On October 20, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released the nearly 700-page, final rule for payments to health care providers and suppliers participating in accountable care organizations (“ACOs”) under the Medicare Shared Savings Program (“MSSP”). In response to approximately 1,320 public comments to the proposed rule, the final rule makes a number … Continue Reading
The dog days of summer may officially be behind us, but things are just starting to heat up over at the Centers for Medicare and Medicaid Services (CMS) with signs that a Medicare Shared Savings Program (MSSP) final rule could be released in the near future. This week, Modern Healthcare is reporting that the Office of … Continue Reading
By Daniel J. Vukelich, AMDR Many healthcare executives may still be on the fence about the future impact of accountable care organizations (ACOs), but most of them still believe their institutions will ultimately join an ACO, according to FierceHealthcare‘s report on the results of a survey released by U.S. News and Fidelity Investments earlier this week. According … Continue Reading
Despite entering the Dog Days of Summer, ACO developments continue to unfold in a flurry. The week started with The New York Times’ Robert Pear reporting that HHS will be hiring consultants to serve as secret healthcare shoppers, to check wait times for primary care physicians. Clearly not well received, that plan was reversed just two … Continue Reading
As Robert Pear reported in The New York Times, “Obama administration officials are recruiting a team of ‘mystery shoppers’ to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.” The Administration is looking to determine exactly how difficult it is … Continue Reading
The American Medical Association (AMA) recently issued its comments to CMS relating to the proposed Medicare Shared Savings Program ACO regulations. The comments cover numerous areas of the proposed regulations, and overall, the AMA makes clear its concern that the program as currently proposed provides insufficient incentives for physician participation. While acknowledging that the ACO … Continue Reading
By Daniel J. Vukelich, AMDR Earlier this week, HealthLeaders Media addressed the Top 10 Clinical Integration, ACO Physician Questions. Noting that physicians may be skeptical of new ACO arrangements, want to know how ACOs will impact their patients, and frankly how doctors will get compensated, the authors list the top ten most frequently asked questions about clinical integration (CI) and … Continue Reading
I recently co-presented a session regarding ACO’s with Tony Colarossi of Plante Moran. We presented to the Michigan Hospital Association Excellence in Governance Fellows. The audience consisted of hospital board members who participate in the fellowship program. The board members were from hospitals large and small. The audience was keenly interested in the topic and … Continue Reading
We already know our John Kirsner as a frequent speaker and blogger regarding how CMS’ Accountable Care Organization regulations would impact health care delivery. Seeing Modern Healthcare’s Joe Carlson recognize him as such is further affirmation that Squire, Sanders, & Dempsey is building on its well deserved reputation as thought leaders in the future of … Continue Reading
We love seeing our bloggers gain recognition. Today, Dan Vukelich, blogger and President/CEO of the Association of Medical Device Reprocessors offers an insightful bylined news article that headlines today’s Hospital Informer, a Fierce Healthcare news outlet distributed to 15,000 hospital management subscribers. The article offers an understanding of how the FDA-approved practice of third party reprocessing for certain … Continue Reading
The results from the five year “Group Practice Demonstration” project, which incentivized ten leading health systems if they could reduce costs by “treating older patients more efficiently while providing high-quality care,” were reported June 1 in the Washington Post. Although the article acknowledges that the test does not completely reflect the blueprint for ACOs eventually offered by CMS, … Continue Reading
At a recent briefing on ACOs, sponsored by Alliance for Health Reform and The Commonwealth Fund, a senior CMS official acknowledged what many in the provider community have been grumbling since the ACO proposed rules were released in March that the ACO program, as currently projected, sets too high a bar for participation and provides insufficient rewards … Continue Reading
